Interview with Beth Eaby, MSN, CRNP, OCN
Ms Eaby is Nurse Practitioner for Outpatient Thoracic Oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, Pennsylvania.
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Patient education: explaining adjuvant therapy
DR LOVE: The final person I chatted with was oncology nurse and lung cancer specialist Ms Beth Eaby who began by commenting on the usual condition of patients who are being evaluated for consideration of adjuvant therapy.
MS EABY: Usually, they’re pretty well recovered from the surgery by the time they see us. We usually see them somewhere between three to six weeks postoperatively. And sometimes patients are still on a Percocet here or there or having some chest soreness. But for the most part, they’ve recovered from their surgical symptoms and they’re feeling pretty good. They’ve been told about their diagnosis by the surgeon, usually, and it’s usually pretty accurate. And I would say about 80 percent of the time, they know that they’re there to discuss adjuvant chemotherapy.
DR LOVE: How do you explain to them what adjuvant therapy is? We interviewed four patients who’ve received adjuvant therapy for this program. And one of the things that struck me as I listened to them was that each one of them talked about being told by the surgeon that, quote, they got it all and, quote, they were cured, and yet they’re coming in to be considered for chemotherapy. And those two things seem a little bit different. How do you explain to patients what’s going on?
MS EABY: I hear the, quote-unquote, I got it all almost with every patient. And I don’t want to downplay that, because I think it’s important for their emotional status to say, “Yeah, they did. Your surgery was very successful, and you had the single best treatment for this stage of disease, which is surgery.” But I tell them in as upbeat of a way as I can that – and all of it depends on their stage – but many times this has a better chance of coming back than not.
And then they say, “Well, why would that be?” And I tell them, “Well, because a lot of times some of the cells” – sometimes I’ll say – “got out of the barn,” or they “migrated out from that original tumor, and they could be circulating in the bloodstream or the lymphatic system and we just can’t see them right now on any kind of scan.”
DR LOVE: And I guess the other thing that’s kind of difficult – and it’s not just lung cancer, because they see the exact same situation in breast cancer and colon cancer – that we can only make educated guesses about what the chance is that the cancer really still is there and is going to grow and get to be a problem. We can’t tell for sure in any individual patient whether or not it’s going to come back. Is that your take on it?
MS EABY: Yeah. I mean, I tell patients that they might be cured sitting in front of me, without taking any treatment. And they might get the treatment, and they could not be cured. And even though they got the treatment, it may not work. And we, unfortunately, at this time, don’t have a good way to predict who that’s going to be. And that’s a large problem.
DR LOVE: We’ve talked to a lot of patients about that. And I think the idea of the fact that there’s some kind of calculated risk and, if the tumor’s bigger, the risk is higher, if the nodes are there, it’s higher, but there’s some kind of number. It might be 20-30 percent, or it might be, as you say, a situation greater than 50 percent that it might come back, and that the idea that that number, that risk, can be reduced somewhat, not made go away, but reduced somewhat with so-called adjuvant therapy.
MS EABY: Right. I mean, we discuss that. And a lot of patients will say to me, “Oh, so, this chemotherapy is like a life insurance policy or something,” and I say, “Well, it is, but it’s reducing the risk.” I always feel that I have to tell them, “I can’t say that taking this treatment is going to for sure make this not come back, because our treatments, unfortunately, aren’t that good yet.”
DR LOVE: I guess the one thing, though, that is important is to consider that the purpose of adjuvant therapy is to increase the chance of cure.
MS EABY: Absolutely.
DR LOVE: And are you able to sit down with any individual patient and, if they want, give them numbers on what their risk is of it coming back with and without treatment?
MS EABY: Yes.
DR LOVE: What would be an example of a situation, let’s say someone who has a smaller tumor, relatively, and the nodes are negative, of that coming back with or without treatment?
MS EABY: So, if it was a Stage I – and we would break that down to Stage IA or Stage IB – if the patient has a Stage IA, we actually don’t offer them adjuvant chemotherapy, because there’s been no proven benefit for that. So, I tell them that they probably have greater than 80-percent chance that they’re cured from the surgery alone and that adding chemotherapy is really not going to benefit them.
